anyone speculate suffocation while sleeping?

anyone speculate suffocation while sleeping?

I've read that Byers wife's cause of death was suffocation, but is sitting undetermined...Anyone interested in speculating how someone can die of suffocation whilst asleep next to their husband? Just think this is odd...maybe so does her coroner etc..

In the bedroom, they seized as evidence three towels and a shirt, all found on the bed; "suspected marijuana and paraphernalia"; a couple of glasses, one of which was believed to contain peach schnapps; and "seven different types of prescription medication prescribed for Melissa Byers," all of which the investigators listed.(347)

Melissa was unconscious when the medics arrived.(345) She was pronounced dead at the hospital an hour and ten minutes later.

But the doctors were perplexed. They told the sheriff that they could find no evidence of trauma on her body,..

the sheriff immediately called for help from the Arkansas State Police. Within two hours of the call for an ambulance, a team of state police investigators had gathered at the hospital. The state police investigated the death as a "possible homicide"

investigators noted the presence of "IV puncture marks on the top of both her feet, on the inside of her right wrist, and on her upper right thoracic area". The right thoracic puncture mark and the right wrist puncture mark were both covered by Band-aids, suggesting that they might have resulted from efforts to revive Melissa at the hospital. But other puncture marks were not bandaged. The investigators took fourteen photographs of the body, which they identified by number in their report.

, the witness reported that "Melissa and Mark were having family troubles lately, and that Mark had a girlfriend by the name of Mandy....She also said that she believes that Melissa has been taking Dilaudids [sic] and Zanex [sic]."

". In the bedroom, they seized as evidence three towels and a shirt, all found on the bed; "suspected marijuana and paraphernalia"; a couple of glasses, one of which was believed to contain peach schnapps; and "seven different types of prescription medication prescribed for Melissa Byers," all of which the investigators listed.(347)

The neighbor told the investigator that Byers had called him a little after 5 p.m. The neighbor said Byers "advised him that he could not wake up Melissa and asked him to come over and see if she had a pulse".

He] advised he checked for a pulse, lifted her eyelids, and looked at her eyes. He advised that he told John Mark to do CPR on her and he started it. He advised that she gurgled up some fluids,

. "he advised that at the hospital, Mark told him he was afraid Melissa had overdosed on a drug that is in the streets in Memphis." The neighbor said 'that Byers told him it could be bought for fifty dollars on the street. He told him the name of the drug. He could not remember it, but thought it started with the letter "D".

Byers said principally that he and his wife had taken a nap, and that when he'd gottn up, he'd found he could not wake her. (349).

The report said her urine tested positive for marijuana and hydromorphone, the synthetic narcotic commonly known as Dilaudid. (Dilaudid is highly prized on the black market, and its street price at the time of Melissas death was about $50 per tablet). Melissa did not have a prescription for Dilaudid.

Though Byers vowed that he would never say anything bad about his late wife, he noted that shed begun abusing drugs long before theyd met. Shed had a heroin and Dilaudid habit, he said, which hed tried to help her break..

ALPRAZOLAM (XANAX)

Melissa had a prescription for Alprazolam, or Xanax. This was removed from the house the day of her death.

Note:

Alprazolam should not be administered to individuals prone to drug abuse. Caution should be observed in all patients who are considered to have potential for psychological dependence.

Benzodiazepines (Alprazolam is a benzodiazepine) may potientiate or interact with effects of other CNS acting drugs such as alcohol (Melissa drank), narcotics, barbiturates, nonbarbiturate hypnotics, antihistamines, phenothiazines, butyrophenones, MAO inhibitors, tricyclic antidepressants and anticonvulsants. Therefore, if alprazolam is to be combined with other drugs acting on the CNS (central nervous system), careful consideration should be given to the pharmacology of the agent involved because of the possible additive or potentiating effects. Patients should also be advised against the simultaneous use of other CNS depressant drugs and should be cautioned not to take alcohol during the administration of alprazolam.

Be sure to tell our doctor and pharmacist if you are taking any of the listed prescription and non-prescription drugs, ..,

(includes)

Paxil

Contraindications

Use of alprazolam should be avoided in individuals with the following conditions:

(Includes)

Acute intoxication with alcohol, narcotics, or other psychoactive substances.

Severe liver deficiencies (Melissa died with an enlarged liver)

Recreational Use:

Alprazolam, like all benzodiazepines, has the potential for abuse, especially in individuals prone to addiction. Although it is not manufactured illegally, it is often diverted to the black market. The state of relaxation, anxiolysis, disinhibition, and euphoria induced by benzodiazepines is the main reason for their illicit use.

It is often used in conjunction with marijuana or heroin to potentiate the relaxing effect. It is also sometimes used by heroin addicts to suppress withdrawal symptoms.

Normal dosage: Use up to 8 months only!!

LITHIUM (found in her system and a prescription removed from the home)

Melissa was also taking Lithium. A lithium prescription was removed from the home the day of her death, and lithium was found in her system after death.

Central nervous system side effects may occur when lithium is used with antidepressants , for example(includes) Paxil. Melissa had a prescription for Paxil. (Imapramine (Tofranil) was also on the central side effects danger list. Side note)

Also noted was that when patients taking Lithium also used carbamazepine (Tegretol) together, some patients may experience side effects (as a side note)

Lithium can also cause changes in the electrocardiogram, low blood pressure, and decreased heart rate.

.The following side effects suggest that lithium blood levels may be too high, and that the dose of lithium may need to be reduced (after comfirmation by measurement of lithium levels in blood): loss of appetite, visual impairment, tiredness, muscle weakness, muscle fasciculations (twitches), tremor, unsteady gait, confusion, seizure, arrhythmias, slurred speech, coma.

.The loss of too much water or salt from your body can lead to serious side effects from this medication. Make sure you drink enough water in hot weather, during activities that cause you to sweat (exercise, sauna, hot baths), or when you have the flu and are experiencing vomiting and/or diarrhea. (lithium toxicity)

What should I discuss with my doctor before taking lithium?

(Includes)

Medications you have taken in the past to treat bipolar disorder.

All other medications you are currently taking and any medication allergies you may have.

Because of toxicity problems, lithium is rarely prescribed by nonpsychiatric physicians and is therefore not among the most widely used psychotherapeutic agents. It accounts for considerably less than 3 percent of total prescriptions for psychotherapeutic drugs by all physicians.

While insulin actually functions to help the metabolism of sugar in the body, lithium does nothing so positive. Instead, it interferes with nerve transmission in general, slowing down the responses of the brain.

In the late stages of lithium toxicity, the patient may become delirious and succumb to seizures and coma.

Trazodone ( Desyrel, Trialodine ) can be used in the treatment of any type of depression. It is also used to reduce the symptoms of agoraphobia, drug induced insomnia, essential tremor, repetitive screaming, and some pain syndromes. Trazodone ( Desyrel, Trialodine ) works by changing the actions of chemicals in the brain. Trazodone ( Desyrel, Trialodine ) is used to relieve symptoms of depression such as feelings of sadness, worthlessness, or guilt; loss of interest in daily activities; changes in appetite; tiredness; sleeping too much; insomnia; and thoughts of death or suicide. Trazodone ( Desyrel, Trialodine ) may also be used for purposes other than those listed in this medication guide.

Be sure to tell your doctor (when taking Desyrel) if you are taking any of the following:

(Includes)

Medications for anxiety, mental illness or pain, Tegretol

PAXIL (Melissas prescription medicine Paxil removed from the home)

.Caution is advised when Paxil is coadministered with other drugs or agents that may affect the serotonergic neurotransmitter systems, such as tryptophan, triptans, serotonin reuptake inhibitors, linezolie, lithium, tramadol, or St. Johns Wort.

..Since there is little clinical experience, the concurrent administration of paroxetine (Paxil) and lithium should be undertaken with caution.

Paxil (Paroxetine) is an anti-depressant drug that affects the chemicals that nerves in the brain use to communicate with one another.

When taking Paxil, talk to your doctor before taking any medicine for pain, arthritis, fever, or swelling. This includes aspirin (removed from the home was Midol, which contains aspirin) ibuprofen, naproxen, (etc.)..

Tell your doctor before taking Paxil if you are taking any of the following medications:(Includes)

Lithium

Any other antidepressants

There may be other drugs that can affect Paxil.

Trazadone (Desyrel) may interact with Paxil Both Paxil and Desyrel have an effect on serotonin, a chemical that is found in the brain. Excess levels of serotonin in the brain may cause serious or potentially life threatening side effects. Early signs of this problem include increased confusion and restlessness. Other possible symptoms may include weakness, fever, nausea, and anxiety. In rare cases, high levels of serotonin in the brain may cause severe complications like seizures, stroke, and even death.

This interaction is poorly documented and is considered major in severity.

DILAUDID (Found in Melissas system)

Dilaudid is a central nervous system depressant and intensifies the effects of alcohol. Do not drink alcohol when taking this medicine. (Melissa drank alcohol)

The concomitant use of other central nervous system depressants including sedatives or hypnotics, general anesthetics, phenothiazines, tranquilizers and alcohol may produce additive depressant effects. Respiratory depression, hypotension and profound sedation or coma may occur. When such combined therapy is contemplated, the dose of one or both agents should be reduced. Dilaudid should not be taken with alcohol. Poid analgesics, including Dilaudid, may enhance the action of neuromuscular blocking agents and produce an excessive amount of respiratory depression.

Dilaudid should be used with caution if you are in a weakened condition or if you have a severe liver or kidney disorder, hypothyroidism, Addisons disease, severe lung problems, an enlarged prostate, a urethral stricture, low blood pressure or a head injury.

Its important to tell the doctor if youve ever suffered from alcoholism or other drug dependencies. Abusing Dilaudid, or combining it with other nervous system depressants, can cause serious and possibly life threatening side effects.Dilaudid suppresses the cough reflex; therefore, the doctor will be cautious about prescribing Dilaudid after an operation or for patients with a lung disease.

High doses of Dilaudid may produce labored or slow breathing. This drug also affects centers that control breathing rhythm and may produce irregular breathing. People who already have breathing difficulties should be very careful about taking Dilaudid.

Dilaudid can cause seizures when taken in high doses.

It is especially important to check with your doctor before combining Dilaudid with any of the following:(Includes)

Antihistamines (Benadryl)

Other central nervous system depressants

Tranquilizers such as Xanax

Central Nervous System Depressants: (list)

(Includes)

Alprazolam (Xanax)

Desyrel also is a central nervous system depressant

CNS depressants should not be combined with any medication or substance that causes sleepiness, including prescription pain medicines, certain over-the-counter cold and allergy medications, or alcohol. If combined, they can slow breathing, or slow both the heart and respiration, which can be fatal.

Interactions

CNS depressants should be used with other medications, such as antidepressant medications, only under a physician's supervision. Certain herbal remedies, such as Valerian and Kava, may dangerously exacerbate the effects of certain CNS depressants. Also, ingesting a combination of CNS depressants, such Valium and alcohol, for example, is not advised. When mixed together, CNS depressants tend to amplify each other's effects, which can cause severely reduced heart rate and even death.

Overdoses of depressants produce effects that are the same as alcohol overdoses. The person becomes extremely drowsy and passes out. Their heartbeat slows and respiration will become shallow. Their skin may feel cold and clammy, and death may result from respiratory failure

CNS depressants should be used in combination with other medications only under a physician's close supervision. Typically, they should not be combined with any other medication or substance that causes CNS depression, including prescription pain medicines, some OTC cold and allergy medications, and alcohol. Using CNS depressants with these other substances - particularly alcohol - can slow both the heart and respiration and may lead to death.

Quote: Oral Hydromorphone (Dilaudid) Linked to Risk for Respiratory DepressionOn June 8, the FDA approved safety labeling changes for hydromorphone HCl oral liquid and 8-mg tablets (Dilaudid, made by Abbott Laboratories, Inc) to warn of the risks for abuse and respiratory depression associated with their use. Use of these products can also adversely affect patients with head injuries and those with sulfite allergies. Hydromorphone is a potent opioid agonist that is classified by the FDA as a schedule II substance. Schedule II opioid agonists, such as hydromorphone, methadone, morphine, oxycodone, oxymorphine, and fentanyl, have the highest potential for abuse and associated risk for fatal overdose and for respiratory depression. The possibility of abuse, whether legal or illicit, should be considered when prescribing or dispensing hydromorphone, particularly for patients with a personal or family history of substance abuse (eg, drugs and alcohol) or mental illness (eg, depression). Although opioids may remain appropriate for use in these patients, they require intensive monitoring for signs of abuse. The FDA notes that hydromorphone has been reported as being abused by crushing, chewing, snorting, or injecting the dissolved product practices that pose a significant risk for overdose or death. However, concerns regarding abuse, addiction, and diversion should not prevent the proper management of pain. Healthcare professionals are advised to contact their State Professional Licensing Board or State Controlled Substances Authority for information regarding the prevention and detection of hydromorphone abuse or diversion. The FDA also warned that concomitant use of hydromorphone with other central nervous system depressants is linked to an increased risk for respiratory depression, hypotension, profound sedation, and coma. When coadministering hydromorphone with other opioids, sedatives, hypnotics, tranquilizers, general anesthetics, phenothiazines, skeletal muscle relaxants, alcohol, or other central nervous system depressants, significant dose reduction of one or both agents is advised. Because concomitant use of agonist-antagonist analgesics (eg, pentazocine, nalbuphine, butorphanol, and buprenorphine) can reduce the analgesic effects of pure opioids and/or precipitate withdrawal symptoms, they should be used with caution in patients who have received or are receiving a course of therapy with hydromorphone. The FDA notes that respiratory depression is more likely to occur in the elderly and those who have conditions accompanied by hypoxia or hypercapnia, (Hypercapnia is a condition where there is too much carbon dioxide (CO2) in the blood. Carbon dioxide is normally expelled through the lungs. Hypercapnia is generally caused by hypoventilation, lung disease, or diminished consciousness.) when even moderate therapeutic doses can dangerously decrease pulmonary ventilation. Oral hydromorphone should therefore be used with extreme caution, and the initial dose reduced in the elderly, patients with chronic obstructive pulmonary disease or cor pulmonale, and those having a substantially decreased respiratory reserve, hypoxia, hypercapnia, or preexisting respiratory depression. For these patients, even usual therapeutic doses of opioid analgesics can decrease respiratory drive while simultaneously increasing airway resistance to the point of apnea. The respiratory depressant effect of oral hydromorphone with carbon dioxide and secondary elevation of cerebrospinal fluid pressure may be markedly exaggerated in the presence of head injury, other intracranial lesions, or preexisting increases in intracranial pressure. Opioid analgesics, including oral hydromorphone, may produce effects on pupillary response and consciousness that can obscure the clinical course and neurologic signs related to further intracranial pressure increases in patients with head injuries. Because oral hydromorphone contains sodium metabisulfite, it can cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people. Although the overall prevalence of sulfite sensitivity in the general population is unknown and thought to be low, it is more likely to be present in patients with asthma rather than in those without asthma. Hydromorphone oral liquid and 8-mg tablets are indicated for the management of pain in patients where an opioid analgesic is appropriate.

www.medscape.com/viewarticle/544514

Quote:BOXED WARNING Dilaudid-HP (High Potency) is a highly concentrated solution of hydromorphone, a potent Schedule II controlled opioid agonist..... Schedule II opioid agonists, including morphine, oxymorphone, oxycodone, fentanyl and methadone, have the highest potential for abuse and risk of producing respiratory depression. Alcohol, other opioids and central nervous system depressants (sedative-hypnotics) potentiate the respiratory depressant effects of hydromorphone, increasing the risk of respiratory depression that might result in death.

Misuse, Abuse, and Diversion of Opioids Hydromorphone is an opioid agonist of the morphine-type. Such drugs are sought by drug abusers and people with addiction disorders and are subject to criminal diversion.....

Interactions with Alcohol and Drugs of Abuse Hydromorphone may be expected to have additive effects when used in conjunction with alcohol, other opioids, or illicit drugs that cause central nervous system depression.

Head Injury and Increased Intracranial Pressure .....Opioid analgesics including Dilaudid-HP may produce effects on pupillary response and consciousness which can obscure the clinical course and neurologic signs of further increase in pressure in patients with head injuries.

WARNINGS Respiratory Depression .....Respiratory depression is more likely to occur in the elderly, in the debilitated, and in those suffering from conditions accompanied by hypoxia or hypercapnia when even moderate therapeutic doses may dangerously decrease pulmonary ventilation.

Misuse, Abuse, and Diversion of Opioids Hydromorphone is an opioid agonist of the morphine-type. Such drugs are sought by drug abusers and people with addiction disorders and are subject to criminal diversion..... Interactions with Alcohol and Drugs of Abuse Hydromorphone may be expected to have additive effects when used in conjunction with alcohol, other opioids, or illicit drugs that cause central nervous system depression. Head Injury and Increased Intracranial Pressure .....Opioid analgesics including Dilaudid Oral Liquid and Dilaudid 8 mg Tablets (hydromorphone hydrochloride) may produce effects on pupillary response and consciousness which can obscure the clinical course and neurologic signs of further increase in intracranial pressure in patients with head injuries. Sulfites Contains sodium metabisulfite, a sulfite that may cause allergic-type reactions including anaphylactic symptoms and life-threatening or less severe asthmatic episodes in certain susceptible people.....

Sedative hypnotics (Xanax), Dilaudid Severe respiratory depression is more likely to occur when the sedative-hypnotic is ingested with other CNS depressants.

Hepatomegaly (Melissas liver and spleen were enlarged)Definition:Hepatomegaly is the enlargement of the liver beyond its normal size. Hepatosplenomegaly is enlargement of both the liver and the spleen -- see splenomegaly .Alternative Names:Hepatosplenomegaly; Enlarged liver; Liver enlargement

Considerations:The lower edge of the liver normally comes just to the lower edge of the ribs (costal margin) on the right side. In its normal state, the edge of the liver is thin and firm, and it cannot be palpated (felt with the finger tips) below the edge of the costal margin.If the liver becomes enlarged enough that it can be palpated below the costal margin, the patient may have hepatomegaly. The diagnosis must be confirmed by an imaging study of the liver.The liver is involved in many bodily functions, and is affected by a variety of conditions, many of which result in hepatomegaly. General causes include infection (viral, bacterial, or parasitic), malignancy (cancer or tumors), anemias , storage diseases, heart failure, congenital heart disease, toxins, and metabolic disturbances.

VALPROIC ACID (found in Melissas system)Valproic acid is a chemical compound that has found clinical use as an anticonvulsant and mood-stabilizing drug, primarily in the treatment of epilepsy and bipolar disorder. It is also used to treat migraine headaches and schizophrenia. In epileptics, valproic acid is used to control absence seizures, tonic-clonic seizures (grand mal), complex partial seizures, juvenile myoclonic epilepsy and the seizures associated with Lennox-Gastaut syndrome. It is also used in treatment of myoclonus. In some countries, parenteral (administered intravenously) preparations of valproate are used also as second-line treatment of status epilepticus, alternatively to phenytoin.

Common side effects are dyspepsia and/or weight gain. Less common are dysphoria, fatigue, dizziness, drowsiness, hair loss, headaches, nausea, sedation and tremors. Valproic Acid also causes Hyperammonemia.Rarely, valproic acid can cause blood dyscrasia, impaired liver function, jaundice, thrombocytopenia, and prolonged coagulation times.Temporary liver enzyme increase has been reported in 20% of cases during the first few months of taking the drug. Inflammation of the liver (hepatitis), the first symptom of which is jaundice, is found in rare cases.

Valproic acid may cause serious or life threatening damage to the liver. The risk of developing liver damage is greatest in children who are younger than 2 years old and in people who are taking more than one medication to prevent seizures, or who have any of the following conditions: a severe seizure disorder and mental retardation; certain inherited diseases that prevent the body from changing food to energy normally; any condition that affects the ability to think, learn, and understand; or liver disease.

If you notice that your seizures are more severe or happen more often or if you experience any of the following symptoms, call your doctor immediately: excessive tiredness, lack of energy, weakness, stomach pain, loss of appetite, nausea, vomiting, or swelling of the face. Valproic acid may cause serious or life-threatening damage to the pancreas. This may occur at any time during your treatment.

Why is this medication prescribed?Valproic acid is used alone or with other medications to treat certain types of seizures. Valproic acid is also used to treat mania (episodes of frenzied, abnormally excited mood) in people with bipolar disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). It is also used to prevent migraine headaches, but not to relieve headaches that have already begun. Valproic acid is in a class of medications called anticonvulsants. It works by increasing the amount of a certain natural substance in the brain.

Quote:www.clinchem.org/cgi/cont...t/34/5/890 Valproic acid and the liver D Cotariu and JL Zaidman Assaf Harofeh Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Zerifin, Israel. Valproic acid (VPA) is widely used as an anticonvulsant, but therapy with the drug has been associated with hepatotoxicity, either reversible hepatic dysfunction or irreversible hepatic failure. Both clinical and experimental studies have revealed several VPA-related biochemical abnormalities in the liver: inhibition of the beta- oxidation and synthesis of fatty acids and inhibition of gluconeogenesis, urea synthesis, oxidative phosphorylation, and the glycine cleavage system. Other abnormalities noted include alteration in the protein conformation of the internal mitochondrial membrane, hyperammonemia, and increased bile flow. The mechanisms of such hepatotoxicity, whether mediated by VPA or by its metabolites, are still little understood. Susceptibility to VPA hepatotoxicity may be enhanced by such conditions as starvation, inborn errors of metabolism, additional neurological disease, and concomitant administration of enzyme-inducing drugs.

About Enlarged Hearts (Melissa had an enlarged heart and an artery supplying blood to the atriventricular mode (internal pacemaker) was narrowed. A single focus of 50% atherosclerotic narrowing was present in the right coronary artery).

www.guidant.com/webapp/em...ev2=causes

What Are the Causes and Risk Factors of Heart Failure?The causes of heart failure vary with age and family history. However, the causes have one thing in common they somehow damage the heart muscle and it no longer pumps as well as it should. The risk factors below are general guidelines. For example, not everyone who has had a heart attack will develop heart failure. But heart attack survivors are certainly at higher risk. Any one, or a combination, of these high-risk factors can lead to heart failure.

Coronary Artery Disease and Heart AttackYour heart muscle has its own blood vessels, called coronary arteries, which carry oxygen-rich blood to the heart walls. What happens when a clogged vessel interrupts blood flow to the heart muscle? A heart attack occurs when a portion of the muscle is permanently damaged. Not enough oxygen-rich blood flows to the heart tissues.

The severity of a heart attack depends on how much heart muscle is damaged and how long the muscle went without oxygen. If you have had a heart attack, you are five times as likely to develop heart failure.

Enlarged HeartWhen the heart becomes enlarged (called cardiomyopathy), it can weaken the heart muscle and cause it to pump with less force. Causes of an enlarged heart include drug abuse, alcohol abuse, or viral infections.www.heartinfo.org/ms/guides/4/main.html

What health problems are associated with cardiac enlargement?

With the exception of exercise-induced enlargement, all forms of cardiac enlargement are abnormal and associated with further problems, including heart failure, irregular heart rhythms , and an increased risk of angina and heart attack. Heart failure results because thickened or dilated heart muscle cannot function effectively as a pump. The diseased muscle cells in both types of enlargement are also capable of causing irregular heart rhythms that can lead to passing-out or sudden death. Because the processes which cause hypertrophy typically do not increase the amount of heart blood vessels to match the thickened heart muscle, the consequences of decreased blood flow to the heart, angina and heart attack, are more common. All of this contributes to an increased risk of death and decreased quality of life for most of those with cardiac enlargement. Treatments are available to help most of these problems.

Quote:www.theshorthorn.com/arch...04-02.html Enlarged heart cause of death An autopsy report points to natural causes in the death of a student Sept. 27. By Marti Harvey and Tristan Vawters The Shorthorn Staff An autopsy performed by the Tarrant County Medical Examiners office revealed that a student found dead in his Arbor Oaks apartment Sept. 27 died of natural causes.

The autopsy, performed by Daniel J. Konzelmann, stated that Matthew Richards death was due to cardiomegaly an enlarged heart. Dr. Konzelmann could not be reached for comment.

The condition may be caused by high blood pressure, heart valve damage, inflammation of the heart muscle, severe anemia, underactive or overactive thyroid excessive iron in the body or abnormal buildup of protein in an organ. The condition may cause no symptoms and go undetected unless recognized by an ultrasound or chest X-ray.

The 22-year-old urban and public affairs graduate student was found around 7 p.m. after his mother called UTA police.

His mother had not heard from him in a few days, which was unusual, so she asked them to check on him, said Dave Richard, Matthews father. They called that evening and told us they had found him. We were shocked.

His father said the family was not aware of his heart condition and that no X-rays had ever indicated a problem.

He was a fitness nut, his father said. His grandfather was a professional athlete, and he had an enlarged heart, so we wonder if that had something to do with it.

Dave said Matthew ran about three miles in the morning and in the evening and speculated that may have had something to do with it.

We think it was half inherited and half working out too much, he said.

Matthew, a magna cum laude graduate of Lyon College in Batesville, Ark., came to UTA in August after receiving the Dr. Clarence Adams Endowed Scholarship for graduate studies. He was pursuing a masters degree in urban planning.

At Lyon College, Matthew was voted the top business student and served on the Deans Advisory Staff. He also traveled extensively through Japan, the Mediterranean and the Baltic regions of Europe to study other cultures and lifestyles.

Matthew was a fine boy, Dave said. He never complained about anything. But since this has happened, I would suggest everyone get an ultrasound and physical examination before exercising, even if they have no complaints.

www.americanheart.org/pre...ntifier=14

What is sudden cardiac death (SCD)?Sudden cardiac death (SCD), or cardiac arrest, is the sudden, abrupt loss of heart function in a person who may or may not have diagnosed heart disease. The time and mode of death are unexpected. It occurs instantly or shortly after symptoms appear. The most common reason for patients to die suddenly is cardiovascular disease, in particular, coronary heart disease. About half of all deaths from coronary heart disease are sudden and unexpected, regardless of the underlying disease. Thus, half of all deaths due to atherosclerosis (arteries lined with fatty deposits) are sudden. So are half of deaths due to degeneration of the heart muscle, or to cardiac enlargement in patients with high blood pressure. Sudden cardiac death is a major health problem, causing about 330,000 deaths each year among U.S. adults either before reaching a hospital or emergency room

The term "massive heart attack" is often mistakenly used in the media to describe sudden death. The term "heart attack" or myocardial infarction refers to death of heart muscle tissue due to the loss of blood supply, not necessarily resulting in the death of the heart attack victim. While a heart attack may cause cardiac arrest and sudden cardiac death, the terms aren't synonymous.

What causes sudden cardiac death?SCD, or cardiac arrest, may be caused by almost all known heart diseases. Most cardiac arrests occur when the diseased heart begins to exhibit rapid and/or chaotic activity ventricular tachycardia or fibrillation. Some are due to extreme slowing of the heart. All these events are called life-threatening arrhythmias.

Heart disease. Underlying heart disease is nearly always found in victims of sudden cardiac death. Typically in adults this takes the form of atherosclerosis. Two or more major coronary arteries are narrowed in 90 percent of cases; scarring from a prior heart attack is found in two-thirds of victims. Therefore, the risk factors for sudden cardiac death include similar risk factors for atherosclerosis, such as smoking and high blood pressure.A heart that's scarred or enlarged from any cause is prone to develop life-threatening ventricular arrhythmias. The first six months after a heart attack is a particularly high-risk period for sudden cardiac death in patients with atherosclerotic heart disease. A thickened heart muscle from any cause (typically high blood pressure or valvular heart disease) especially when there's congestive heart failure too is an important predisposing factor for sudden cardiac death.Heart medications. Under certain conditions, various heart medications can set the stage for arrhythmias that cause sudden cardiac death. In particular, so-called "antiarrhythmic" drugs, even at normally prescribed doses, sometimes may produce lethal ventricular arrhythmias ("proarrhythmic" effect). Regardless of whether there's organic heart disease, significant changes in blood levels of potassium and magnesium (from using diuretics, for example) also can cause life-threatening arrhythmias and cardiac arrest.Hypertrophic cardiomyopathy. When sudden cardiac death occurs in young adults, atherosclerotic heart disease usually isn't the cause. More often these young victims have a thickened heart muscle (hypertrophic cardiomyopathy) without having high blood pressure. For more information, read more about hypertrophic cardiomyopathy.

Electrical abnormalities. Certain electrical abnormalities within the heart also may cause sudden cardiac death in the young. These include a short circuit between the upper and lower chambers (Wolff-Parkinson-White syndrome). This sometimes can allow dangerously rapid rates to develop in the lower chamber when there's a rapid rhythm disturbance in the upper chamber and a congenitally prolonged electrical recovery after each heartbeat (long-QT syndrome). These may set the stage for fatal ventricular arrhythmias.Blood vessel abnormalities. Less often, inborn blood vessel abnormalities, particularly in the coronary arteries and aorta, may be present in young sudden death victims. Adrenaline released during intense physical or athletic activity often acts as a trigger for sudden cardiac death when these predisposing conditions are present.Recreational drug abuse. In people without organic heart disease, recreational drug abuse is an important cause of sudden cardiac death.

Brown-red dried fluid found in the oral cavity and on the lips (p.2, External Examination)

There is mention of red and brown fluid in her mouth and in her airway. This finding is consistent withedema fluid, caused by anoxia (lack of oxygen to the blood which turns it brownish), and may suggestthat the victim, Melissa Byers, may have died from suffocation. When suffocative deaths occur usinga pillow or the equivalent placed over the face of the victim, or the victim's face being pushed into thepillow, there are usually no marks or patterns left behind, and no petechiae of the sclera andconjunctive.

There was no elucidation regarding this fluid in the opinion section of the autopsy report, and nomention of any report regarding laboratory analysis done on this fluid to determine its nature andorigin.

Quote:This finding is consistent withedema fluid, caused by anoxia (lack of oxygen to the blood which turns it brownish), and may suggestthat the victim, Melissa Byers, may have died from suffocation

It also may suggest other possibilities.

Quote:When suffocative deaths occur usinga pillow or the equivalent placed over the face of the victim, or the victim's face being pushed into thepillow, there are usually no marks or patterns left behind

Quote:There was no elucidation regarding this fluid in the opinion section of the autopsy report, and nomention of any report regarding laboratory analysis done on this fluid to determine its nature andorigin.

At the end of September 1996, a month after Byers' appearance in court, investigator Witt received the medical examiner's report on Melissa. It noted that she had been 68 inches tall and weighed 211 pounds. Both wrists bore multiple, well-healed, linear scars. A tattoo of a heart and scroll were present on her right upper back, with the name "Christopher" written in the scroll. No distinct scarred needle tracks were present.

However other needle marks were evident. Two of those, which were covered with bandages, were clearly the result of unsuccessful medical attempts at cardiopulmonary resuscitation, as were a couple of fractured ribs. The origin of the other needle puncture wounds--in the groin, arms, and feet--was undetermined.

There were a few small bruises on the body, some or all of which may have occurred on the way to and at the hospital. And there were some signs of deteriorating health, such as obesity, narrowing of some arteries, and a gallstone. But none of the conditions the pathologists observed would normally prove fatal, either alone or in combination.

Under the circumstances, they were particularly interested in what toxicology tests would reveal. But those findings did not solve the riddle of Byers' death either. Although a glass of peach schnapps had been found at her bedside, she had apparently drunk very little, as no alcohol was detected in her system. Nor were any opiates were found in her blood. Traces of one of her prescribed medications, an anti-seizure medicine used to treat post-traumatic stress syndrome, were present, as were traces of lithium, a medication that had been prescribed for her to treat manic depression. But that was all, and the amounts of neither of those substances exceeded therapeutic levels.

Only her urine was abnormal. It tested positive for marijuana and for hydromorphone, the synthetic narcotic more commonly known as Dilaudid. Melissa Byers did not have a prescription for Dilaudid. On the street, it sells as much as $50 per tablet. The drug is a potent opiate. It can slow breathing, heart rate, and brain activity. What was strange was that, while the drug showed up in Melissa Byers' urine, suggesting recent use, it was not found in her blood, which would be expected of a lethal agent. Moreover, that anomaly in the body was matched by an anomaly in the report.

Through what Jim Clark, the director of the crime lab, recently described as a "typographical error," no mention of the finding of Dilaudid appeared in the autopsy report's conclusions. Instead, on the report's final page, the word "hydromorphone," or Dilaudid, appeared as "hydrocodone," which is another drug entirely. Nor was the Dilaudid mentioned on the page listing the medical examiner's findings.

Asked if the discovery of an illegal drug in the body of a possible homicide victim was not a finding worth listing, Clark affirmed that, "There may be room for some further investigation as to how she obtained the drug." As for the needle marks in the body's arms, feet, and groin, Clark said, "In the pathologist's opinion, all those wounds were probably done at the hospital."

When Witt received the report, it offered no indication that Byers' death might be connected to illegal drug activity. Instead, he had the crime lab's vague conclusion that, "because of the lack of definitive anatomic or toxicological findings, the cause and manner of death are left undetermined." According to Clark, the causes of about 4 to 8 percent of deaths that are presented to medical examiners nationally are found to be undetermined.

He was also disappointed with the way the ambulance workers treated Melissa, who he said had drunk a little peach schnapps before the two of them had settled down for a nap at 3:30. When he woke up at quarter to five, he tried to awaken her but she didn't respond. "When the paramedics came in, they jerked her off the bed and onto the floor. They didn't shock her with the paddles but one time. That kind of bothered me. They kind of acted like they didn't care, like, 'Well, good. She's dead. Maybe now he'll leave.' I just felt like they didn't care if she died or not."

Byers had not seen the autopsy report on Melissa, which only became public in December, when the State Police closed their investigation. Asked about the reported comment by his neighbor Norm Metz, that when Melissa was brought to the hospital Byers had said, "he was afraid Melissa had overdosed on a drug that is in the streets in Memphis," the name of which he thought "began with the letter 'D,' and that "could be bought for $50 on the street," Byers denied having made such a statement. He also denied telling Metz, as Metz had reported to police, that "he thought her death was a drug overdose and that they were going to accuse him of smothering her."

a comment was made by Byers to his neighbour "that he'll get the blame for suffocating her"....and also that the autopsy revealed this coloured fluid in mouth/surrounds that suggested possible suffocation yet this wasn't tested....